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Showing results for "caused".

4861. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/852463/psn-pdf
      August 16, 2023 - Staying safe while getting well. August 16, 2023 Salamon M. Harvard Women's Health Watch. August 1, 2023 https://psnet.ahrq.gov/issue/staying-safe-while-getting-well Patients can help minimize the potential for adverse events while in the hospital. Actions such as working with a care partner, tracking medications,…

4862. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44934/psn-pdf
      February 07, 2023 - National Safety Standards for Invasive Procedures (NatSSIPs2). February 7, 2023 Centre for Perioperative Care. London, UK; January 2023. https://psnet.ahrq.gov/issue/national-safety-standards-invasive-procedures-natssips Patients face risks when undergoing surgery. This revised guidance provides recommendations de…

4863. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35770/psn-pdf
      January 02, 2017 - Actions and implementation strategies to reduce suicidal events in the Veterans Health Administration. January 2, 2017 Mills PD, Neily J, Luan D, et al. Actions and Implementation Strategies to Reduce Suicidal Events in the Veterans Health Administration. The Joint Commission Journal on Quality and Patient Safety. …

4864. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44472/psn-pdf
      January 22, 2016 - Understanding medical errors and adverse events in ICU patients. January 22, 2016 Garrouste-Orgeas M, Flaatten H, Moreno R. Understanding medical errors and adverse events in ICU patients. Intensive Care Med. 2016;42(1):107-9. doi:10.1007/s00134-015-3968-x. https://psnet.ahrq.gov/issue/understanding-medical-errors…

4865. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/36323/psn-pdf
      November 14, 2018 - Our long journey towards a safety-minded just culture. Part II: where we're going. November 14, 2018 ISMP Medication Safety Alert! Acute Care Edition. September 21, 2006;11:1-2. https://psnet.ahrq.gov/issue/our-long-journey-towards-safety-minded-just-culture-part-ii-where-were-going This second part of this series…

4866. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/60236/psn-pdf
      April 15, 2020 - Seattle pilot’s misdiagnosis highlights challenges around coronavirus testing. April 15, 2020 Malone P, Kamb L. Seattle Times. March 30, 2020. https://psnet.ahrq.gov/issue/seattle-pilots-misdiagnosis-highlights-challenges-around-coronavirus-testing False negative test results can contribute to misdiagnosis, treatm…

4867. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43247/psn-pdf
      August 02, 2015 - Characteristics of medical professional liability claims against internists. August 2, 2015 Mangalmurti SS, Harold JG, Parikh PD, et al. Characteristics of medical professional liability claims against internists. JAMA Intern Med. 2014;174(6):993-5. doi:10.1001/jamainternmed.2014.1116. https://psnet.ahrq.gov/issue…

4868. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46465/psn-pdf
      February 21, 2018 - Preventing mistransfusions: an evaluation of institutional knowledge and a response. February 21, 2018 MacDougall N, Dong F, Broussard L, et al. Preventing Mistransfusions: An Evaluation of Institutional Knowledge and a Response. Anesth Analg. 2018;126(1):247-251. doi:10.1213/ANE.0000000000002443. https://psnet.ah…

4869. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38576/psn-pdf
      April 22, 2009 - A case of mistaken identity: staff input on patient ID errors. April 22, 2009 Ortiz J, Amatucci C. A case of mistaken identity: staff input on patient ID errors. Nurs Manag. 2009;40(4):37-41. doi:10.1097/01.NUMA.0000349689.98615.6d. https://psnet.ahrq.gov/issue/case-mistaken-identity-staff-input-patient-id-errors …

4870. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/48090/psn-pdf
      August 28, 2019 - Preventing errors with high-risk medications. August 28, 2019 Wiley F. Drug Topics. August 2019;1633:16-18. https://psnet.ahrq.gov/issue/preventing-errors-high-risk-medications High-alert medications have the potential to cause serious patient harm if not administered correctly. Reporting on challenges to medicati…

4871. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/43011/psn-pdf
      May 20, 2014 - Early warnings, weak signals and learning from healthcare disasters. May 20, 2014 Macrae C. Early warnings, weak signals and learning from healthcare disasters. BMJ Qual Saf. 2014;23(6):440-5. doi:10.1136/bmjqs-2013-002685. https://psnet.ahrq.gov/issue/early-warnings-weak-signals-and-learning-healthcare-disasters …

4872. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/74031/psn-pdf
      November 03, 2021 - Emergency department crowding: the canary in the health care system. November 3, 2021 doi:10.1056/CAT.21.0217. https://psnet.ahrq.gov/issue/emergency-department-crowding-canary-health-care-system Emergency department (ED) overcrowding and boarding can result in worse patient outcomes and increased risk of medical…

4873. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/50373/psn-pdf
      September 25, 2019 - 2019 update on medical overuse: a review. September 25, 2019 Morgan DJ, Dhruva SS, Coon ER, et al. 2019 update on medical overuse: a review. JAMA Intern Med. 2019;179(11):1568. doi:10.1001/jamainternmed.2019.3842. https://psnet.ahrq.gov/issue/2019-update-medical-overuse-review Medical overuse has been described as…

4874. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42767/psn-pdf
      November 27, 2013 - Barcode medication administration work-arounds: a systematic review and implications for nurse executives. November 27, 2013 Voshall B, Piscotty R, Lawrence J, et al. Barcode medication administration work-arounds: a systematic review and implications for nurse executives. J Nurs Adm. 2013;43(10):530-535. doi:10.1…

4875. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47821/psn-pdf
      May 22, 2019 - Patient Safety. May 22, 2019 National Pharmacy Association; NPA. https://psnet.ahrq.gov/issue/patient-safety-15 This website for independent community pharmacy owners across the United Kingdom features both free and members-only guidance, reporting platforms, and document templates to support patient safety. It i…

4876. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46593/psn-pdf
      November 08, 2017 - Unreadable barcodes and multiple barcodes on packages can lead to errors. November 8, 2017 ISMP Medication Safety Alert! Acute care edition. October 19, 2017;22:1-3. https://psnet.ahrq.gov/issue/unreadable-barcodes-and-multiple-barcodes-packages-can-lead-errors Barcodes can both enhance and degrade the medication …

4877. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37023/psn-pdf
      September 24, 2010 - Applying the Toyota Production System: using a patient safety alert system to reduce error. September 24, 2010 Furman C, Caplan RA. Applying the Toyota Production System: using a patient safety alert system to reduce error. Jt Comm J Qual Patient Saf. 2007;33(7):376-386. https://psnet.ahrq.gov/issue/applying-toyot…

4878. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/50646/psn-pdf
      November 06, 2019 - My patient almost died from a mistake I made. I apologized and it changed my life. November 6, 2019 McLean K. Huffington Post. October 16, 2019. https://psnet.ahrq.gov/issue/my-patient-almost-died-mistake-i-made-i-apologized-and-it-changed-my-life Medical mistakes cause stress for both patients and their clinician…

4879. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42182/psn-pdf
      April 10, 2013 - Why do GDPs fail to recognise oral cancer? The argument for an oral cancer checklist. April 10, 2013 Dave B. Why do GDPs fail to recognise oral cancer? The argument for an oral cancer checklist. Br Dent J. 2013;214(5):223-5. doi:10.1038/sj.bdj.2013.214. https://psnet.ahrq.gov/issue/why-do-gdps-fail-recognise-oral-…

4880. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/39352/psn-pdf
      July 05, 2013 - When the 5 rights go wrong: medication errors from the nursing perspective. July 5, 2013 Jones JH, Treiber LA. When the 5 rights go wrong: medication errors from the nursing perspective. J Nurs Care Qual. 2010;25(3):240-247. doi:10.1097/NCQ.0b013e3181d5b948. https://psnet.ahrq.gov/issue/when-5-rights-go-wrong-medi…